VAAFT PROCEDURE (Video-assisted Anal Fistula Treatment) versus open method in the treatment of high fistula in ano

Background: A common acquired anorectal condition is anal fistula. The treatment approaches that have been employed have been linked to erratic outcomes and sometimes life-threatening consequences. Video-assisted anal fistula treatment (VAAFT), a minimally invasive method, was introduced for adult patients in 2011. Objective: To know the efficacy of the VAAFT procedure in treating high anal fistulas and to compare it to open methods in the Basrah province. Methods: The present study was performed on 200 patients with high fistulas in ano in Basrah province. We divided the patients into 2 groups: Group A: treated by the VAAFT technique and Group B: treated by open fistulotomy Results: The patients treated with VAFFT revealed no occurrence of the following postoperative complication: Infection, incontinence, recurrence, anal stenosis, and bleeding. There was lower incidence of pain, short time for wound healing, rapid return to work, and more patient satisfaction compared with open fistulotomy Conclusion: An innovative method for managing ano fistula is VAAFT. Compared with traditional methods, it has a lot of benefits. It is day case surgeryno open wound.no damage to anal sphincter and no risk of incontinence, it is more affordable.it allow for clear identification of internal office, whole tract and its associated branches and cavity. The instrument can be used for multiple patients after good sterilization and disinfection. (AU)

Surgical robot: a tool or toy / 中华消化外科杂志

Laparoscopic surgery is a revolution in the fields of surgery in the 21st century. The concept of minimally invasive surgery has been widely accepted. Nowadays, the commercial robot-assisted laparoscopic instrument operating system, commonly known as "surgical robot", does not yet have the attributes of a real robot and still needs further optimization. We are still far from claiming that we are in the "surgical robot era". A new generation of surgical robots with more developed artificial intelligence and simulation functions are worth working on for. "Minimally invasive approach" does not necessarily mean "minimally invasive surgery". The real benefit of patients is the most important indicator for evaluating minimally invasive surgery. The essence of science is discovery but not technological fashion. In the face of rapid technological development, the Chinese surgeons should remain rational and enterprising.

Abordaje lateral retropleural mínimamente invasivo para hernia de disco torácica gigante calcificada: reporte de caso / Minimally Invasive Lateral Retropleural Approach for Calcified Giant Thoracic Disc Herniation: Case Report

Introducción: Las hernias de disco torácicas (HDT) representan solo el 0.15-1.8% de las hernias de disco tratadas quirúrgicamente. Se han descrito distintos tipos de abordajes que reportan diferentes índices de éxito y complicaciones. El objetivo es presentar el caso quirúrgico de una HDT resuelta por un abordaje lateral retropleural mínimamente invasivo y exponer las ventajas del mismo. Descripción: Se presenta el caso de una paciente de 29 años, que consultó por dorsalgia y paresia crural izquierda 4/5. La TC y RM mostraron una HDT gigante calcificada T8-9. Bajo monitoreo neurofisiológico y visión microscópica, se realizó un abordaje lateral retropleural izquierdo mínimamente invasivo, con resección parcial de la costilla para luego utilizar un sistema de dilatadores y retractores tubulares. Se confirmó el nivel bajo radioscopía, y se completó con el drilado de la cabeza costal para exponer el espacio y la HDT calcificada de manera precoz. Se realizó la discectomía del fragmento herniado, incluyendo drilado intracanal de la porción calcificada y se completó la descompresión incluyendo la porción posterior de los platillos vertebrales y el pedículo inferior. Parte del fragmento herniado se encontraba íntimamente adherido al saco dural, por lo que creímos conveniente dejar este remanente para evitar complicaciones. La paciente evolucionó favorablemente, recuperando de manera completa el déficit motor y el dolor que motivaron la consulta. Consideramos que no fue necesario realizar ningún tipo de fusión intersomática. Discusión: Los distintos abordajes propuestos tienen sus ventajas y desventajas. El desarrollo de las técnicas mínimamente invasivas sumado a la posibilidad de exponer precozmente la lesión resultan ventajas importantes en estos casos. La necesidad de fusión es un tema controversial, donde la mayoría de los trabajos sugieren que no es mandatoria. Conclusión: el abordaje lateral retropleural mínimamente invasivo es una técnica segura, que permitió una visualización precoz de la HDT sin desplazar el estuche dural y logrando una adecuada descompresión. Además, evita la morbilidad que podría representar la toracotomía transtorácica y la necesidad de fusión

Introduction: Thoracics disc herniations (TDH) represent just 0.15-1.8% of all surgically treated herniated discs. Many approaches had been described with different amount of success and complications. The objective is to present a TDH surgical case using a minimally invasive lateral retropleural approach and describe the advantages of this approach. Case description: we present a 29 years old female who presented with dorsal pain and right leg weakness 4/5. CT and MRi showed a calcified giant TDH T8-9. The surgery was performed under neurophysiological monitoring and using a surgical microscope. A minimally invasive left lateral retropleural approach was performed, with partial resection of a rib. Finally, we used dilators and tubular retractors. After radioscopic confirmation of T8-9, we completed the approach by drilling rib ́s head in order to early expose the spinal canal with the TDH. We resected the herniated fragment of the TDH, drilled the calcified intraspinal canal portion and completed the decompression including the posterior portion of the endplates and the inferior pedicle. The most anterior portion of the TDH was intimately attached to the dural sac, so we decided to leave this remanent in order to avoid complications. The patient had a good postoperative recovery, the leg weakness and pain improved significantly. From our perspective, we consider that no intersomatic fusion was necessary. Discusion: each approach has it advantages and disadvantages. The evolution of minimally invasive techniques together with the early visualization of TDH became important advantages in these cases. The need of fusion remains controversial, and most of the literature suggest that is not mandatory. Conclusión: the minimally invasive lateral retropleural approach is a safe technique that offers an early visualization of the TDH without manipulation of the dural sac and allows an adequate decompression. Furthermore, this approach avoids the morbidity of a transthoracic approach and the requirement of fusion.

Perioperative outcomes of mitral valvuloplasty via totally thoracoscopic approach versus traditional median sternotomy / 中国胸心血管外科临床杂志

@#Objective    To compare the efficacy and safety of mitral valvuloplasty via minimally invasive approach with those of mitral valvuloplasty via traditional median sternotomy. Methods    A total of 1 221 patients undergoing mitral valvuloplasty from January 2015 to August 2018 in Guangdong Provincial People's Hospital were analyzed retrospectively, including 721 males and 500 females, with an average age of 47.2±15.1 years. According to the different surgical methods, they were divided into a study group (n=654), who received mitral valvuloplasty via the totally thoracoscopic approach, and a control group (n=567), who received mitral valvuloplasty via traditional median sternotomy. Clinical data, surgical results, and perioperative outcomes of the two groups were compared. Results    There was no significant difference in preoperative general data between the two groups (P>0.05). Compared with the control group, the study group had longer cardiopulmonary bypass time and aortic cross-clamping time (146.7±42.4 min vs. 122.7±30.6 min, 96.2±32.7 min vs. 78.3±23.8 min, both P=0.000), and shorter total operation time (227.4±55.3 min vs. 238.1±56.4 min, P=0.001). There was no significant difference in the incidence of secondary cross-clamping and mitral valve replacement between the two groups (3.7% vs. 2.6%, P=0.312; 1.7% vs. 1.4%, P=0.690). The blood transfusion rate and the incidence of respiratory tract infection and postoperative poor wound healing were lower (13.0% vs. 24.5%, 2.1%vs. 18.0%, 1.5% vs. 5.3%, all P=0.000) and the postoperative hospital stay was shorter (6.2±4.4 d vs. 11.5±8.8 d, P=0.000) in the study group. There was no significant difference in hospitalization expense between the two groups (95 847.9±31 322.0 yuan vs. 99 673.1±47 930.3 yuan, P=0.149). Within 30 d after surgery, 1 patient died in the study group and 4 patients died in the control group. Before discharge, there were 4 and 5 patients with severe mitral valve regurgitation in the study group and the control group, respectively. Conclusion    Compared with mitral valvuloplasty via traditional median sternotomy, minimally invasive mitral valvuloplasty is superior in shortening operation time and postoperative hospital stay, lowering blood transfusion rate, and reducing postoperative complications, which can achieve better clinical outcomes.

Claudicación, resultados funcionales y calidad de vida en artroplastía total de cadera primaria con abordaje anterolateral mínimamente invasivo / Claudication, functional outcomes and quality of life in primary Total hip arthroplasty with minimally invasive anterolateral approach

Resumen: Introducción: La coxartrosis tiene incidencia de 88 casos por 100,000 personas/año y prevalencia sintomática de 16% para hombres y 6% para mujeres en edades de 65-74 años e incrementa con la edad. Representa una enfermedad de salud pública que va en aumento, la mujer es quien presenta padecimiento más grave. La ATC (artroplastía total de cadera) se ha convertido en el procedimiento más exitoso para mejorar la calidad de vida de pacientes con coxartrosis. Objetivo: Determinar la claudicación, calidad de vida y resultados funcionales de la ATC mediante abordaje mínimo invasivo en pacientes con coxartrosis primaria. Material y métodos: Estudio longitudinal y prospectivo en pacientes con coxartrosis primaria unilateral postoperados de ATC primaria con técnica mínimamente invasiva en el período comprendido de Marzo de 2015 a Febrero de 2016, se analizó a cada paciente con somatometría, calidad de vida (WOMAC), funcionalidad en pacientes con coxartrosis (HHS) y funcionalidad en pacientes con cirugía de cadera (OHS) de manera prequirúrgica y postquirúrgica con seguimiento a un año. Resultados: Se incluyeron 21 pacientes, 17 femeninos y cuatro masculinos que corresponde a 80.95 y 19.05%, respectivamente, edad promedio de 59.95 años (DE = 9.64), con resultados funcionales excelentes a un año, según escalas de HHS y OHS, calidad de vida alta en 100% de los casos según WOMAC, con índice de claudicación bajo de 4.76%. Discusión: El abordaje mínimo invasivo es una técnica quirúrgica reproducible con resultados funcionales excelentes, índice de claudicación baja y alta calidad de vida en pacientes postoperados de ATC primaria durante el primer año de seguimiento.

Abstract: Introduction: The coxarthrosis has incidence of 88 cases per 100,000 people/year and symptomatic prevalence of 16% men and 6% women aged 65-74 years and increases with age. It is a growing public health disease. Total hip arthroplasty (THA) has become the most successful procedure to increase the quality of life of patients with coxarthrosis. Our objective was to determine the claudication, quality of life and functional results of THA through minimal invasive approach in patients with primary coxarthrosis. Material and methods: Prospective longitudinal study in patients with unilateral primary coxarthrosis postop of THA with minimally invasive approach from March 2015-February 2016, each patient was analyzed with quality of Life instrument (WOMAC), Functional test for coxarthrosis (HHS) and functional test in patients with hip surgery (OHS) with follow-up of one year. Results: We included 21 patients, 17 female and 4 males corresponding to 80.95% and 19.05% respectively, average age of 59.95 years (ED = 9.64), with excellent functional results to one year according to HHS and OHS, quality of life high in 100% of cases according to WOMAC, with claudication rate of 4.76%. Discussion: The minimal invasive approach is a reproducible surgical technique, with excellent functional results, low claudication rate and high quality of life in postoperative patients of primary ATC at only one year of follow-up.

Short-and long-term results of SuperPath minimally invasive arthroplasty in the treatment of femoral head necrosis / 临床外科杂志

Objective To study the short-and long-term effects of SuperPath minimally invasive arthroplasty for the treatment of femoral head necrosis.Methods The subjects were 50 patients with femoral head necrosis.Randomly divided into the control group and observation group with 25 cases in each group.The patients in the control group were treated with total hip replacement through anterolateral small incision.The patients in the observation group were treated with minimally invasive total hip replacement through SuperPath incision.Compared two groups of the perioperative indexes and the incidence of complications, and all patients were followed up for 6 months, compared before and after operation of the Harris hip function score and visual analogue method were evaluated.Results The observation group of the drainage flow[ (211.83±23.76) ml], intraoperative blood loss[ (354.06±38.28) ml], hospitalization time[ (8.74±1.53) d], the difference of leg length[ (12.97±3.05) mm] and thigh circumference[ (5.41±0.58) mm] was significantly lower than the control group[ (150.49±18.61) ml, (213.95±30.24) ml, (4.52±1.06) d, (8.12±2.30) mm and (2.87±0.51) mm, respectively] (P＜0.05).1 year after operation, the Harris score (89.30±4.19) and Barthel index (90.63±4.95) in the observation group were significantly higher than the control group (81.86±5.24, 79.47±5.36) (P＜0.05).VAS score was significantly lower in observation group (0.85±0.43) than that in control group (2.09±0.61) (P＜0.05).The incidence of complications in the two groups was not significantly different (P＞0.05).Conclusion SuperPath incision minimally invasive total hip arthroplasty for the treatment of avascular necrosis of the femoral head has advantages such as small trauma, low complication and significant effect.It can relieve pain and promote hip joint function and quality of life recovery.

Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach

PURPOSE: As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intraarticular calcaneus fractures in elderly patients in two groups: ELA and MIA. MATERIALS AND METHODS: Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments. RESULTS: No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36-item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group. CONCLUSION: The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.

Clinical analysis of small incision minimally invasive approach in treatment of infected pancreatic necrosis / 中华外科杂志

Objective@#To investigate the safety and efficiency of small incision minimally invasive approach pancreatic necrosectomy in the treatment of infected pancreatic necrosis.@*Methods@#The data of 164 patients who underwent small incision minimally invasive approach pancreatic necrosectomy for infected pancreatic necrosis at Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from January 2012 to December 2016 were analyzed retrospectively.Among 164 patients, there were 102 male and 62 female patients.The median age was 46 years(ranging from 19 to 79 years). One hundred and one patients(61.6%) suffered from severe acute pancreatitis and 63 patients(38.4%) suffered from moderately severe acute pancreatitis.Following step-up approach principle, the surgical procedures were performed for 131 patients(79.9%) who suffered from sepsis which could not be alleviated via percutaneous catheter drainage(PCD). The other 33 patients(20.1%) who did not undergo PCD directly took small incision minimally invasive approach pancreatic necrosectomy.Preoperative CT images were used to determine the location of the lesion.The PCD puncture points or the points where the abscess was closest to the skin were chosen as the incision.Gradually, the small incision minimally invasive approach pancreatic necrosectomy were performed via cutting all layers into the abscess.@*Results@#The median time from the onset of symptom to first operation was 32 days(ranging from 23 to 45 days). The average hospital stay was 46 days(ranging from 29 to 103 days). The average number of drainage tubes placed was 4 pieces(ranging from 2 to 8 pieces). Ninety-two patients(56.0%) underwent minimal access retroperitoneal pancreatic necrosectomy. Thirty-six patients(22.0%) underwent minimal invasive approach lesser omentum sac pancreatic necrosectomy.Thirty-six patients(22.0%) underwent minimal invasive approach lesser omentum sac pancreatic necrosectomy combined with minimal access retroperitoneal pancreatic necrosectomy.A total of 148 cases(90.2%) were cured via minimally invasive approach pancreatic necrosectomy, 8 cases(4.9%) were cured after transfering to open pancreatic necrosectomy.The cure rate was 95.1%(156/164). The mainly postoperative complications included pancreatic fistula(25 cases), intra-abdominal hemorrhage(10 cases), gastric fistula (2 cases), duodenal fistula(4 cases) and colonic fistula(3 cases). The overall incidence rate of complications was 26.8%(44/164). Eight cases were dead after surgery and the in-hospital mortality was 4.9%(8/164).@*Conclusion@#In summary, small incision minimally invasive approach pancreatic necrosectomy is an effective way to clean up necrotic tissue, improve the drainage, reduce complications in dealing with infected pancreatic necrosis.

Tratamiento de las fracturas de húmero diafisarias distales con abordaje posterior mínimamente invasivo y placa extraarticular anatómica / Treatment of distal diaphyseal humeral fractures with minimally invasive posterior approach and anatomical extraarticular plate

Introducción Las fracturas de húmero diafisarias corresponden al 3-5% de las fracturas en general. La distribución de las fracturas que comprometen el tercio distal de la diáfisis es variable con incidencias estimadas entre el 10 y el 48%. El objetivo del estudio es evaluar los resultados funcionales y la tasa de consolidación de un grupo de pacientes con fractura diafisaria de húmero del tercio distal con técnica mínimamente invasiva por vía posterior. Materiales y métodos Entre 2013 y 2016 se intervino a 23 pacientes, con una media de edad de 36 años. La valoración funcional se realizó por medio de la Escala de Discapacidades del Hombro, el Codo y la Mano (DASH) abreviada y la medición de los arcos de movilidad de hombro y codo con goniometría; el dolor fue evaluado de acuerdo con la Escala Visual Análoga del Dolor (EVA). Resultados Todas las fracturas consolidaron de forma exitosa, excepto dos casos que presentaron retardo en la consolidación. La lesión del nervio radial previa a la intervención se recuperó de forma progresiva sin requerimiento de transferencias. Los resultados funcionales fueron satisfactorios en un grupo de diez pacientes que completaron más de 1 año de seguimiento. Discusión El abordaje posterior de humero con mínima invasión en el tratamiento de este patrón particular de fracturas parece que muestra una ventaja biológica al permitir una consolidación completa en todos los pacientes. La lesión del nervio radial iatrogénica no parece que aumente en relación con su aislamiento y protección en la porción proximal del tríceps. Nivel de evidencia clínica Nivel IV.

Background Diaphyseal humeral fractures correspond to 3-5% of all fractures. The proportion of these fractures in which the distal third of the diaphysis is involved is variable with estimated incidences between 10-48%. The aim of the study is to evaluate the functional results and rate of fracture consolidation for a group of patients with distal third diaphyseal humeral fractures managed using a minimally invasive technique through a posterior approach. Materials and methods Twenty-two patients (mean age of 36 years) were evaluated between 2013 and 2016. Functional assessment was performed using the DASH abbreviated functional scale. Shoulder and elbow mobility range of motion were measured with goniometry, and pain was measured following the VAS scale. Results All fractures consolidated successfully, with two cases exhibiting delay in consolidation. Radial nerve injury prior to the intervention was progressively recovered without the need for supplementary tendons transfers. Functional results were satisfactory for ten patients that completed more than one year of follow-up. Discussion Minimally invasive technique with posterior approach in the treatment of this particular pattern of humeral fractures seems to show a biological advantage in allowing complete consolidation in all patients. Iatrogenic radial nerve injury does not appear to increase in relation to its isolation and protection in the proximal portion of the triceps. Evidence level IV.

Comparison of outcomes of two minimally invasive approaches for multi-vessel coronary revascularization / 北京大学学报(医学版)

Objective:To compare the safety and effectiveness of two minimally invasive approaches for multi-vessel coronary revascularization.Methods:From August 2014 to February 2017,70 consecutive patients who underwent minimally invasive coronary artery bypass grafting in Peking University Third Hospital were randomly divided into two groups.In one group,40 patients underwent staged-hybrid coronary revascularization (staged-HCR) treatment;in the other group,30 patients underwent minimally invasive total arterial revascularization with bilateral internal thoracic artery (BITA).In staged-HCR group,the patients underwent minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI) procedure for treatment of multi-vessel disease.In BITA group,the patients underwent total arterial coronary artery bypass grafting with composite "Y" BITA graft.Preoperative and postoperative data of the two groups,including postoperative blood usage,mechanical ventilation time,domiciling duration in intensive care unit (ICU),major adverse cerebral and cardiovascular event (MACCE),and postoperative coronary angiography results were compared,in order to evaluate the safety and effectiveness of these surgical approaches.Results:The preoperative characteristics of 70 patients in the two groups showed no significant difference.All the patients underwent successfully,elective minimally invasive multi-vessel coronary artery bypass grafting as scheduled preoperatively.Postoperative result showed the patients in staged-HCR group took advantages in less postoperative mechanical ventilation time [Staged-HCR group (11.2 ± 8.7) h vs.BITA group (18.3 ± 9.1) h,P =0.013],shorter domiciling duration in ICU [Staged-HCR group (26.29 ± 4.05) h vs.BITA group (44.74 ± 28.75) h,P =0.022],and less total drainage [Staged-HCR group (695.57 ± 250.46) mL vs.BITA group (1 103.26±547.44) mL,P =0.03] than the patients in the group of minimally invasive total arterial revascularization with BITA.Postoperative in hospital coronary angiography showed satisfactory graft patency rates in both groups [97.5％ in Staged-HCR group vs.97.8％ in BITA group].No MACCE occurred in both groups during hospitalization.Conclusion:Staged-HCR is a feasible method for the treatment of multi-vessel revascularization involving right coronary artery.Minimally coronary revascularization with BITA is associated with superior long-term graft patency and it's recommended for patients who could not tolerate dual-antiplatelet therapy.This study shows that both minimally invasive surgical approaches are safe and effective for treatment of patients with multi-vessel coronary artery disease.

Diagnosis and minimally invasive treatment of adrenal tumors / 中国肿瘤临床

Minimally invasive approach has been the gold standard therapy for adrenal tumor since 1992. The improvements of endo-crine test and radiographic options that are used to evaluate adrenal lesion relevance ratio have promoted the diagnosis and treat-ment. Future research may focus on secondary hypertension screening, subclinical situation of functional adrenal tumor, and differen-tial diagnosis through imaging tests and other methods. Subclinical hypercortisolism and the relationship between incidentaloma and metabolism should be given particular importance. Laparoscopic adrenalectomy has become the gold standard approach for adrenal benign tumor treatment. The indication for usage of this approach has extended and included adrenal carcinoma (tumor size ranging within 6-10 cm) and pheochromocytoma larger than 6 cm. Partial adrenalectomy mainly depends on surgeon's experience. In addi-tion, the perioperative period of minimally invasive surgery need further research. This paper reviews related studies.